New patient forms

Click on the 4 Forms below to open, print and fill out prior to your initial visit:

Notice of privacy practices

At Obery Dental, we work hard to ensure your privacy and maintain the confidentiality of your information and dental records. We follow a federal law called, Health Insurance Portability and Accountability Act (HIPAA), which is designed to protect the privacy and confidentiality of patient information. We insist that our staff observe patient confidentiality, respecting your right to privacy about your dental records and experience at Obery Dental.

If you have any comments, questions or concerns regarding your privacy at Obery Dental, please contact Diane Pham, RPh, HIPAA Officer, at 508-927-4676.

See our Notice of Privacy Practices in full by clicking HERE.

Payment and Insurances

Payment Policies

Whenever an appointment is scheduled with Dr. Pham you will receive a financial form which will provide all fees, estimated insurance and amount due at the appointment. Deposits for lab work on crowns and other restorative items are generally 50% at the time the work is sent to the lab. This is usually equal to what an insurance co-pay would be.


We accept major credit cards and CareCredit:


CareCredit is a healthcare credit card designed for your health, beauty, and wellness needs. It's a way to pay for the costs of many treatments and procedures and allows you to make convenient monthly payments. For complete details of healthcare financing terms, please review the CareCredit account agreement within the application. (Click on CareCredit Logo for more information)



We are a preferred provider for Delta Dental and Blue Cross Blue Shield of MA, however, we accept most insurance plans. We will submit all dental insurance claims. Our staff work hard to ensure our patients receive full insurance benefits but you are ultimately responsible for your account.

If you have any questions or concerns regarding your dental benefits please contact us at 508-927-4676. We will ask for the following information to determine your benefits: Your Name, Phone, Email, Insurance Name, Subscriber's Employer, ID Number on Benefit Card, and Phone Number on Benefit Card.

Appointment Cancellation Policy

Please arrive at least 5 minutes before your scheduled appointment time in order to update personal and/or insurance information. You may reschedule or cancel your appointment 24 hours before your appointment time to avoid a cancellation fee.